Thursday, September 03, 2015

Although it runs contrary to to what some in the `popular press’- and some activists - would like to project, there is a substantial body of evidence showing that antiviral medications – like oseltamivir (aka Tamiflu ®) - can make a real difference in the outcome of severe influenza infection.

Much of the ire surrounding this drug has been garnered through Roche’s long-standing resistance to releasing all of their testing data, and that has led to critical editorials in theBMJ, and frequent excoriation in the British press.

Fueling this fire have been repeated Cochrane group analyses that have found insufficient evidence that the drug reduces seasonal influenza complications in healthy adults, although they limit their analyses to RCTs (Randomized Controlled Trials) of which few exist for this drug.

Sadly, many people (and probably even some doctors) have come away with the erroneous impression that these drugs are worthless – or worse. We saw evidence of this last summer, inCID Journal: Under Utilization Of Antivirals For At Risk Flu Patients, showing that antiviral drugs are underused for at-risk patients, while antibiotics (which don’t work against viral infections) are overused.

Today we’ve new CDC research that looked at the extended care needs of elderly post-hospital-discharge flu patients who either received, or did not receive, early antiviral treatments. As you will see, early administration of antivirals was associated with reductions in length of hospital stays, and reduced odds of needing extended care after discharge.

Abstract

Background. Patients hospitalized with influenza may require extended care upon discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥65 years hospitalized with influenza.

Methods. We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility upon hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay (LOS) using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤4 days) and late (>4 days) in reference to date of illness onset.

Early treatment of flu-hospitalized people 65 and older with flu antiviral medications cuts the duration of their hospital stay and reduces their risk of needing extended care after discharge, a new CDC study finds. The study is the first to look at the benefits of early antiviral treatment on preventing the need for extended care in community-dwelling flu-hospitalized people 65 and older.

Because people 65 and older are at high risk of serious flu complications, CDC recommends that they be treated for flu with influenza antiviral medications as early as possible because these drugs work best when started early. The study, published today in the journal Clinical Infectious Diseases, supports this recommendation.

“Flu can be extremely serious in older people, leading to hospitalization and in some cases long-term disability. This important study shows that people 65 and older should seek medical care early when they develop flu symptoms,” says Dr. Dan Jernigan, director of CDC's Influenza Division.

The study found that community-dwelling patients 65 years and older who sought medical care or who were hospitalized within two days of illness onset and who were treated with antiviral medications early (in the first four days of illness) had hospital stays that were substantially shorter than those who received treatment later (after 4 days of illness onset). This benefit was observed even among those who sought care later (more than two days after they got sick), but the reduction in hospital stay was not as great.

Similarly, early treatment was associated with patients being 25 percent to 60 percent less likely to need extended care after leaving the hospital. The study authors suggest that the shorter hospital stays associated with early treatment could account for the reduced risk of needing extended care after discharge since lengthy bed restriction can lead to disability. Other factors like older age, the presence of neurologic disorders, intensive care unit (ICU) admission, and pneumonia at admission were also independent risk factors for extended care needs.